Health Information Systems (eBook)
XLIV, 340 Seiten
Springer London (Verlag)
978-1-84996-441-8 (ISBN)
Previously published as Strategic Information Management in Hospitals; An Introduction to Hospital Information Systems, Health Information Systems Architectures and Strategies is a definitive volume written by four authoritative voices in medical informatics. Illustrating the importance of hospital information management in delivering high quality health care at the lowest possible cost, this book provides the essential resources needed by the medical informatics specialist to understand and successfully manage the complex nature of hospital information systems. Author of the first edition's Foreword, Reed M. Gardner, PhD, Professor and Chair, Department of Medical Informatics, University of Utah and LDS Hospital, Salt Lake City, Utah, applauded the text's focus on the underlying administrative systems that are in place in hospitals throughout the world. He wrote, "e;These challenging systems that acquire, process and manage the patient's clinical information. Hospital information systems provide a major part of the information needed by those paying for health care."e; their components; health information systems; architectures of hospital information systems; and organizational structures for information management.
Health Information Systems: Architectures and Strategies 2
Foreword from the 1st Edition in 2004 6
Series Preface 8
Preface for the 2nd Edition 9
Acknowledgements for the 2nd Edition 11
Acknowledgements for the 1st Edition 12
Annotation to the Figures 13
Contents 14
List of Figures 21
Figure Credits 31
List of Tables 33
About the Authors 35
1: Introduction 38
2: Health Institutions and Information Processing 40
2.1Introduction 40
2.2 Significance of Information Processing in Health care 40
2.2.1 Information Processing as Quality Factor 40
2.2.2Information Processing as Cost Factor 41
2.2.3Information as Productivity Factor 43
2.2.4Holistic View of the Patient 43
2.2.5Hospital Information System as Memory and Nervous System 44
2.3 Progress in Information and Communication Technology 45
2.3.1Impact on the Quality of Health Care 45
2.3.2Impact on Economics 47
2.3.3Changing Health care 48
2.4 Importance of Systematic Information Management 49
2.4.1Affected People and Areas 49
2.4.2Amount of Information Processing 50
2.4.3Sharing the Same Data 51
2.4.4Integrated Information Processing to Satisfy Information Needs 52
2.4.5Raising the Quality of Patient Care and Reducing Costs 53
2.4.6Basis of Systematic Information Processing 53
2.5 Examples 54
2.5.1Knowledge Access to Improve Patient Care 54
2.5.2Nonsystematic Information Processing in Clinical Registers 55
2.5.3The WHO eHealth Resolution15 56
“The Fifty-Eighth World Health Assembly … 57
2.5.4Estimated Impact of eHealth to Improve Quality and Efficiency of Patient Care 58
2.6 Exercises 59
2.6.1Amount of Information Processing in Typical Hospitals 59
2.6.2Information Processing in Different Areas 59
2.6.3Good Information Processing Practice 60
2.7 Summary 60
3: Information System Basics 61
3.1 Introduction 61
3.2 Data, Information, and Knowledge 61
3.3 Information Systems and Their Components 62
3.3.1Systems and Subsystems 62
3.3.2Information Systems 62
3.3.3Components of Information Systems 63
3.3.4Architecture and Infrastructure of Information Systems 65
3.4 Information Management 66
3.5 Exercises 66
3.5.1On the Term Information System 66
3.5.2On Enterprise Functions 67
3.5.3On Application Components 67
3.5.4On Architectures and Infrastructures 67
3.5.5On Information Management 67
3.6 Summary 67
4: Health Information Systems 69
4.1 Introduction 69
4.2 Hospital Information Systems 69
4.3 Transinstitutional Health Information Systems 72
4.4 Electronic Health Records as a Part of Health Information Systems 74
4.5 Challenges for Health Information Systems 74
4.6 Example 76
4.6.1 Architecture of a Hospital Information System 76
4.7 Exercises 77
4.7.1 Hospital Information System as a System 77
4.7.2 Buying a Hospital Information System 77
4.7.3 Transinstitutional Health Information Systems 77
4.8 Summary 78
5: Modeling Health Information Systems 79
5.1 Introduction 79
5.2 On Models and Metamodels 79
5.2.1Definitions 79
5.2.2Types of Models 81
5.2.2.1Functional Models 81
5.2.2.2Technical Models 82
5.2.2.3Organizational Models 82
5.2.2.4Data Models 84
5.2.2.5Business Process Models 85
5.2.2.6Information System Models 87
5.3 A Metamodel for Modeling Health Information Systems on Three Layers: 3LGM² 87
5.3.1UML Class Diagrams for the Description of 3LGM² 88
5.3.23LGM²-B 91
5.3.2.1Domain Layer 91
5.3.2.2Logical Tool Layer 94
5.3.2.3Physical Tool Layer 96
5.3.2.4Interlayer Relationships 98
5.3.33LGM²-M 102
5.3.43LGM²-S 103
5.4 On Reference Models 104
5.5 A Reference Model for the Domain Layer of Hospital Information Systems 106
5.6 Exercises 107
5.6.1Typical Implementation of Hospital Functions 107
5.6.23LGM² as a Metamodel 107
5.6.3Modeling with 3LGM² 108
5.6.3.1HIS Components 108
5.6.3.2Create the Model 108
5.6.3.3Interlayer Relationships 108
5.6.3.4New Enterprise Function 108
5.7 Summary 109
6: Architecture of Hospital Information Systems 110
6.1 Introduction 110
6.2 Domain Layer: Data to Be Processed in Hospitals 110
6.2.1 Entity Types Related to Patient Care 111
6.2.2 Entity Types About Resources 112
6.2.3 Entity Types Related to Administration 113
6.2.4 Entity Types Related to Management 113
6.3 Domain Layer: Hospital Functions 114
6.3.1 Patient Care 114
6.3.1.1 Patient Admission 114
Appointment Scheduling 116
Patient Identification and Checking for Recurrent 116
Administrative Admission 116
Medical Admission 118
Nursing Admission 118
Visitor and Information Service 118
6.3.1.2 Decision Making, Planning, and Organization of Patient Treatment 118
Decision Making and Patient Information 120
Medical and Nursing Care Planning 120
6.3.1.3 Order Entry 121
Preparation of an Order 121
Appointment Scheduling 123
6.3.1.4 Execution of Diagnostic, Therapeutic and Nursing Procedures 123
Execution of Diagnostic and Therapeutic Procedures 124
Execution of Nursing Procedures 125
6.3.1.5 Coding of Diagnoses and Procedures 125
6.3.1.6 Patient Discharge and Transfer to Other Institutions 126
Administrative Discharge and Billing 127
Medical Discharge and Medical Report Writing 127
Nursing Discharge and Nursing Report Writing 128
6.3.2 Supply and Disposal Management, Scheduling, and Resource Allocation 128
6.3.2.1 Supply and Disposal Management 128
Catering 128
Material and Medication Management 128
Laundry Management 128
Management of Medical Devices 130
6.3.2.2 Scheduling and Resource Allocation 130
6.3.2.3 Human Resources Management 130
6.3.3 Hospital Administration 131
6.3.3.1 Patient Administration 132
6.3.3.2 Archiving of Patient Information 132
Opening of a Patient Record 133
Administration and Allocation of Patient Records 133
Long-Term Archiving 134
6.3.3.3 Quality Management 134
Internal Quality Management 134
Performance of Legal Notification Requirements 135
6.3.3.4 Cost Accounting 135
6.3.3.5 Controlling 135
6.3.3.6 Financial Accounting 136
6.3.3.7 Facility Management 136
6.3.3.8 Information Management3 136
Strategic Information Management 136
Tactical Information Management 139
Operational Information Management 139
6.3.4 Hospital Management 139
6.3.5 Research and Education 139
6.3.5.1 Research Management 141
6.3.5.2 Execution of Clinical Trials and Experiments 141
6.3.5.3 Knowledge Retrieval and Literature Management 141
6.3.5.4 Publishing and Presentation 141
6.3.5.5 Education 141
6.3.6 Clinical Documentation: A Hospital Function? 141
6.3.7 Domain Layer: Exercises 142
6.3.7.1 Differences in Hospital Functions 142
6.3.7.2 Different Health Care Professional Groups and Hospital Functions 142
6.3.7.3 Support of Hospital Functions 142
6.3.7.4 The Patient Entity Type 143
6.3.8 Domain Layer: Summary 143
6.4 Logical Tool Layer: Application Components 145
6.4.1 Patient Administration System 146
6.4.2 Medical Documentation System 148
6.4.3 Nursing Management and Documentation System 150
6.4.4 Outpatient Management System 151
6.4.5 Provider or Physician Order Entry System (POE) 153
6.4.6 Patient Data Management System (PDMS) 155
6.4.7 Operation Management System 157
6.4.8 Radiology Information System 159
6.4.9 Picture Archiving and Communication System (PACS) 160
6.4.10 Laboratory Information System 162
6.4.11 Enterprise Resource Planning System 163
6.4.12 Data Warehouse System 164
6.4.13 Document Archiving System 166
6.4.14 Other Computer-Based Application Components 168
6.4.15 Clinical Information System and Electronic Patient Record System as Comprehensive Application Components 169
6.4.16 Typical Non-Computer-Based Application Components 170
6.4.16.1 The Paper-Based Patient Chart System 170
6.4.16.2 The Paper-Based Patient Record System 172
6.5 Logical Tool Layer: Integration of Application Components 172
6.5.1 Taxonomy of Architectures at the Logical Tool Layer 173
6.5.1.1 Number of Databases: Central Versus Distributed 173
DB1 Style 174
DBn Style 174
Mixed DB1/DBn Style 175
6.5.1.2 Number of Application Components: Monolithic Versus Modular 175
6.5.1.3 Number of Software Products and Vendors: All-in-One Versus Best-of-Breed 176
6.5.1.4 Communication Pattern: Spaghetti Versus Star 177
6.5.2 Integrity 179
6.5.2.1 Object Identity 179
6.5.2.2 Referential Integrity 180
6.5.2.3 Consistency 180
6.5.3 Types of Integration 181
6.5.3.1 Data Integration 181
6.5.3.2 Semantic Integration 181
6.5.3.3 Access Integration 182
6.5.3.4 Presentation integration 182
6.5.3.5 Contextual Integration 183
6.5.3.6 Functional integration 183
6.5.3.7 Process Integration 183
6.5.4 Standards 184
6.5.4.1 Health Level 7 (HL7) Version 2 184
6.5.4.2 Health Level 7 (HL7) Version 3 186
6.5.4.3 Digital Imaging and Communications in Medicine (DICOM) 187
6.5.4.4 ISO/IEEE 11073 188
6.5.4.5 Standard for Contextual Integration 188
6.5.4.6 Integrating the Healthcare Enterprise (IHE) 188
6.5.4.7 Electronic Data Interchange for Administration, Commerce, and Transport (EDIFACT) 189
6.5.4.8 Clinical Document Architecture (CDA) 189
6.5.5 Integration Technologies 190
6.5.5.1 Federated Database System 190
6.5.5.2 Transaction Management: 2-phase commit protocol and master application components 190
6.5.5.3 Middleware 191
Message Exchange by Communication Servers 192
Remote Function Calls 194
Service-Oriented Architectures (SOAs) and Portals 195
6.5.6 Logical Tool Layer: Example 196
6.5.6.1 Typical Realizations: Centralized, Monolithic and All-in-One HIS 196
6.5.7 Logical Tool Layer: Exercises 198
6.5.7.1 Data Distribution Style at the Logical Tool Layer 198
6.5.7.2 HIS Infrastructures 198
6.5.7.3 A Paperless Hospital 201
6.5.7.4 Introducing a Departmental Computer-Based Application Component 201
6.5.7.5 Loose and Close Coupling 202
6.5.7.6 Integrating Nursing Documentation 202
6.5.8 Logical Tool Layer: Summary 202
6.6 Physical Tool Layer: Physical Data-Processing Systems 203
6.6.1 Servers and communication networks 204
6.6.2 Clients 204
6.6.3 Storage 205
6.6.4 Typical Non-computer-Based Physical Data-Processing Systems 205
6.6.5 Infrastructure 206
6.7 Physical Tool Layer: Integration of Physical Data-Processing Systems 207
6.7.1 Taxonomy of Architectures at the Physical Tool Layer 207
6.7.1.1 Distribution of Computing Power: Mainframes vs. Client-Server 208
6.7.2 Physical Integration 209
6.7.3 Computing Centers 210
6.7.4 Physical Tool Layer: Example 211
6.7.4.1 The Amount of Data to Be Processed at a Hospital’s Computing Center 211
6.7.5 Physical Tool Layer: Exercises 212
6.7.5.1 HIS Infrastructure 212
6.7.6 Physical Tool Layer: Summary 212
6.8 Summarizing Example 213
6.8.1 Health Information Systems Supporting Clinical Business Processes 213
Patient Treatment at a Physician’s General Practice 213
Sec154_6 213
Arrival at ward 213
Nursing Admission 213
Medical Admission 214
Medical Care Planning and Order Entry 214
Execution of Diagnostic, Therapeutic, and Nursing Procedures 214
Review of Findings 215
Decision Making 215
Sec162_6 215
Transfer to Another Department 215
Discharge from Hospital and Aftercare 216
6.9 Summarizing Exercises 216
6.9.1 Hospital Functions and Processes 216
6.9.2 Application Components and Hospital Functions 216
6.9.3 Multiprofessional Treatment Teams 217
6.9.4 Information Needs of Different Health Care Professionals 217
6.9.5 HIS Architectures 217
6.9.6 Communication Server 217
6.9.7 Anatomy and Physiology of Information Processing 217
6.10 Summary 218
7: Specific Aspects for Architectures of Transinstitutional Health Information Systems 219
7.1 Introduction 219
7.2 Domain Layer 220
7.2.1 Specific Aspects for Hospital Functions 220
7.2.1.1 Patient Admission 220
7.2.1.2 Decision Making, Planning, and Organization of Patient Treatment 221
7.2.1.3 Execution of Diagnostic and Therapeutic Procedures 221
7.2.2 Additional Enterprise Functions 222
7.3 Logical Tool Layer 222
7.3.1 Integration of Application Components 222
7.3.2Strategies for Electronic Health Record Systems 224
7.3.2.1The Provider-Centric Strategy 225
7.3.2.2The Patient-Centric Strategy 225
7.3.2.3The Regional- or National-Centric Strategy 226
7.3.2.4The Strategy of Independent Health Banks 226
7.4 Physical Tool Layer 226
7.5 Examples 227
7.5.1“Gesundheitsnetz Tirol (GNT)”: The Tyrolean Health Care Network 227
7.5.1.1Background and Overall Functionality 227
7.5.1.2System Architecture and Workflows 227
7.5.1.3 Important Lessons Learned 229
7.5.2 Veterans Health Information Systems and Technology Architecture (VISTA)7 230
7.5.3 The Hypergenes Biomedical Information Infrastructure9, 10 230
7.5.4 The National Health Information System in Korea11, 12 231
7.6Exercises 232
7.6.1Challenges of Transinstitutional Health Information Systems 232
7.6.2Strategies for Transinstitutional Electronic Health Records 232
7.6.3 The Term “Electronic Health Record” 233
7.6.4 Transinstitutional Information Systems in other Sectors 233
7.7 Summary 233
8: Quality of Health Information Systems 234
8.1 Introduction 234
8.2 Quality of Structures 235
8.2.1 Quality of Data 235
8.2.2 Quality of Computer-Based Application Components and Their Integration 236
8.2.3 Quality of Physical Data Processing Systems 238
8.2.4 Quality of the Overall HIS Architecture 239
8.2.5 Exercises 239
8.2.5.1 Quality Criteria in 3LGM² Models 239
8.2.5.2 Quality of Computer-Based Application Components 240
8.2.5.3 Usability of Software Products 240
8.2.5.4 Quality of HIS Architectures 240
8.2.6 Summary 240
8.3 Quality of Processes 241
8.3.1 Single Recording, Multiple Usability of Data 241
8.3.2 No Transcription of Data 241
8.3.3 Leanness of Information Processing Tools 241
8.3.4 Efficiency of Information Logistics 243
8.3.5 Patient-Centered Information Processing 243
8.3.6 Exercises 244
8.3.6.1 Quality of Processes in an Intensive Care Unit 244
8.3.6.2 Transcription of Data 244
8.3.6.3 Leanness of Information Processing Tools 244
8.3.6.4 Quality of Processes 244
8.3.7 Summary 245
8.4 Quality of Outcome 245
8.4.1 Fulfillment of Hospital’s Goals 246
8.4.2 Fulfillment of the Expectations of Different Stakeholders 246
8.4.2.1 Patients and Relatives 247
8.4.2.2 Health Care Professionals 247
8.4.2.3 Administrative Staff 247
8.4.2.4 Hospital Management 248
8.4.3 Fulfillment of Information Management Laws 248
8.4.4 Exercises 249
8.4.4.1 Expectation of Patients and Relatives 249
8.4.4.2 National Laws for Information Processing 249
8.4.5 Summary 249
8.5 Balance as a Challenge for Information Management 249
8.5.1 Balance of Homogeneity and Heterogeneity 250
8.5.2 Balance of Computer-Based and Non-Computer-Based Tools 250
8.5.3 Balance of Data Security and Working Processes 251
8.5.4 Balance of Functional Leanness and Functional Redundancy 252
8.5.5 Balance of Documentation Quality and Documentation Efforts 252
8.5.6 Exercises 253
8.5.6.1 Best-of-Breed Versus All-in-One 253
8.5.7 Summary 253
8.6 Evaluation of Health Information Systems Quality 254
8.6.1 Typical Evaluation Phases 254
8.6.1.1 Study Exploration 255
8.6.1.2 First Study Design 256
8.6.1.3 Operationalization of Methods and Detailed Study Plan 256
8.6.1.4 Execution of Study 257
8.6.1.5 Report and Publication of Study 257
8.6.2 Typical Evaluation Methods 257
8.6.2.1 Quantitative Evaluation Methods 257
Time Measurements 257
Event Counting 258
Quantitative Questionnaires 258
8.6.2.2 Qualitative Evaluation Methods 258
Qualitative Interviews 259
Qualitative Observations 259
Qualitative Content Analysis 259
8.6.2.3 Special Evaluation Studies 259
8.6.3 Exercises 260
8.6.3.1 Selection of Evaluation Criteria 260
8.6.3.2 Planning of an Evaluation Study 260
8.6.3.3 The Baby CareLink Study 261
8.6.4 Summary 261
8.7 Summarizing Examples 261
8.7.1 The Baldrige Health Care Information Management Criteria 261
8.7.2 Information Management Standards of the Joint Commission 262
8.7.3 The Baby CareLink Study18 263
8.7.4 In-Depth Approach: The Functional Redundancy Rate 263
8.8 Summarizing Exercises 268
8.8.1 Evaluation Criteria 268
8.8.2 Joint Commission Information Management Standards 268
8.9 Summary 268
9: Strategic Information Management in Hospitals 270
9.1 Introduction 270
9.2 Strategic, Tactical and Operational Information Management 271
9.2.1Information Management 271
9.2.2Information Management in Hospitals 274
9.2.3Strategic Information Management 275
9.2.4Tactical Information Management 276
9.2.5Operational Information Management 277
9.2.6Relationship Between IT Service Management and Information Management 279
9.2.7Example 281
9.2.7.1Typical Projects of Tactical Information Management 281
9.2.8Exercises 281
9.2.8.1Influences on HIS Operation 281
9.2.8.2Typical Projects of Tactical Information Management 281
9.2.8.3Diagnostics and Therapy of HIS 281
9.2.9Summary 282
9.3 Organizational Structures of Information Management 282
9.3.1Chief Information Officer 282
9.3.2Information Management Department 284
9.3.3Example 284
9.3.3.1Organizational Structures for Information Management 284
9.3.4Exercises 285
9.3.4.1Information Systems Managers as Architects 285
9.3.4.2Organizational Structures for Information Management in a Hospital 286
9.3.4.3Centralization of Organizational Structures 286
9.3.4.4Organizational Structures for Information Management at PMC 286
9.3.5Summary 286
9.4 Strategic Planning 287
9.4.1Tasks 287
9.4.1.1Aligning Business Plans and Information Management Plans 287
9.4.1.2Long-Term HIS Planning 288
9.4.1.3Short-Term HIS Planning 288
9.4.2Methods 289
9.4.2.1Strategic Alignment 289
9.4.2.2Portfolio Management 289
9.4.3The Strategic Information Management Plan 290
9.4.3.1Purpose of Strategic Information Management Plans 290
9.4.3.2Structure of Strategic Information Management Plans 292
Strategic Goals of the Hospital and of Information Management 292
Description of the Current State of the Hospital Information System 293
Analysis and Assessment of the Current State of the Hospital Information System 293
Description of the Planned State of the Hospital Information System 293
Migration Path from the Current to the Planned State 293
9.4.4Example 294
9.4.4.1Structure of a Strategic Information Management Plan 294
9.4.5Exercises 294
9.4.5.1Life Cycle of a Strategic Information Management Plan 294
9.4.5.2Deviation from a Strategic Information Management Plan 294
9.4.5.3Strategic Information Management and Strategic Hospital Management 294
9.4.5.4Establishing a Strategic Information Management Plan 296
9.4.6Summary 296
9.5 Strategic Monitoring 296
Root 296
9.5.1Tasks 297
9.5.1.1Permanent Monitoring Activities 297
9.5.1.2Ad Hoc Monitoring Activities 298
9.5.1.3Certification of HIS 299
9.5.2Methods 300
9.5.2.1HIS Benchmarking 300
9.5.2.2HIS Certification 300
9.5.3Examples 301
9.5.3.1A HIS Benchmarking Report 301
9.5.3.2COBIT 301
Plan and Organize 303
Acquire and Implement 303
Deliver and Support 303
Monitor and Evaluate 303
9.5.3.3CCHIT Functional Quality Criteria 304
9.5.4Exercises 305
9.5.4.1An Information Processing Monitoring Report 305
9.5.4.2COBIT 305
9.5.4.3Most Relevant Key Performance Indicators 305
9.5.4.4Organizing User Feedback 305
9.5.5Summary 305
9.6 Strategic Directing 306
Sec75_9 306
9.6.1Tasks 306
9.6.2Methods 306
9.6.3Example 307
9.6.3.1Project Management Boards at PMC 307
9.6.4Exercise 307
9.6.4.1A Project Management Board at PMC 307
9.6.5Summary 307
9.7Last But Not Least: Education! 308
9.8 Summarizing Examples 308
9.8.1Deficiencies in Information Management 308
9.8.2Computer Network Failures14 309
9.8.3Information Management Responsibilities15 310
9.8.4Safely Implementing Health Information and Converging Technologies 311
9.8.5Increased Mortality After Implementation of a Computerized Physician Order Entry System17 312
9.9 Summarizing Exercises 312
9.9.1Management of Other Information Systems 312
9.9.2Beginning and End of Information Management 312
9.9.3Cultivating Hospital Information Systems 313
9.9.4Hospital Information System Failure 313
9.9.5Increased Mortality 313
9.9.6Relevance of Examples 313
9.9.7Problems of Operational Information Management 313
9.10 Summary 314
10: Strategic Information Management in Health Care Networks 316
10.1 Introduction 316
10.2 Description of Health Care Networks 317
10.3 Organizational Structures of Information Management in Health Care Networks 317
10.3.1Centrality of Information Management in Health Care Networks 317
10.3.2Intensity of Information Management in Health Care Networks 319
10.4 Types of Health Care Networks 319
10.5 Example 320
10.5.1Regional Health Information Organizations 320
10.6Exercise 321
10.6.1The Plötzberg Health Care Network 321
10.7 Summary 321
11: Final Remarks 323
Thesaurus 325
Recommended Further Readings 358
Index 361
| Erscheint lt. Verlag | 18.1.2011 |
|---|---|
| Reihe/Serie | Health Informatics | Health Informatics |
| Zusatzinfo | XLIV, 340 p. |
| Verlagsort | London |
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Allgemeines / Lexika |
| Sozialwissenschaften ► Politik / Verwaltung | |
| Technik ► Medizintechnik | |
| Schlagworte | Health • information systems • Strategies |
| ISBN-10 | 1-84996-441-6 / 1849964416 |
| ISBN-13 | 978-1-84996-441-8 / 9781849964418 |
| Haben Sie eine Frage zum Produkt? |
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